Should non-clinical staff risk their lives for the NHS?

The debate continues over which NHS staff should stay home. Many non-clinicians, and even some clinicians, are deeply unhappy with their employers’ instructions to come to work – which seems at odds with government advice.

The position of non-clinical staff might seem like a side issue in the current crisis. It is not.

For a start, non-clinical staff in the NHS number around 500,000. They and their families probably represent around two per cent of the population. That is a big enough number in a pandemic for any mistakes or misunderstandings to make a real difference.

The other reason is some non-clinical staff – on top of obvious roles including cleaners, porters, cooks etc – are needed to help hospitals and other healthcare settings deal with the surge in coronavirus cases. There is an enormous amount to do in a very short time – both in directly supporting clinicians and in reconfiguring the service to cope with the pandemic. Deciding who should take on this task in a fair, transparent and effective manner, matters.

Both those sitting at home when they are needed at work, and their many colleagues traipsing into the office for no good reason are a threat to tackling coronavirus.

Confusion about who should be working

A look at the Asthma UK Facebook or Twitter accounts reveal many NHS staff are concerned their condition is not being considered by their employers (as well as some who praise the understanding of occupational health teams and others).

The list of “shielded patients” issued by the government will inevitably include many NHS staff (clinical and non-clinical), yet employers do not always appear to be incorporating this advice into their guidance to staff.

HSJ has also received reports from clinicians who could be delivering their services remotely or who are undertaking management tasks, yet still find themselves being required to come into work simply because they are clinicians.

Advice to both clinicians and non-clinicians appears to vary, sometimes very significantly, across NHS organisations and often within them. There is widespread variance from the national guidance given to the general population and, within organisations, from corporate policy – as we saw recently at Newcastle.

Time and again, HSJ has heard of managers interpreting national and organisational guidance in an inconsistent and sometimes odd fashion. The wording of some policies stresses the need to come to work, rather than the need to stay safe, and has an unwritten subtext that staff are not to be trusted.

Is the NHS like the army?

In the army, you are a soldier first and a cook or driver second. If you are ordered to pick up a gun and shoot someone, you do it.

What about the NHS – should working for the service obligate you to do whatever is necessary in times of crisis? Does it matter if you work for a clinical commissioning group and you are “volunteered” for service at the local trust? Who gets to do the “volunteering” and who is exempt from being sent into frontline service? Does it depend on seniority? In some cases, it appears so.

On the other hand, there is an emergency to respond to, as eloquently set out by one of the commentators on HSJ’s original editorial.

“At my trust, we pushed staff to go home quite early. However, we are now finding that we need people to come back and do jobs outside of their comfort zone - an incident management rota, project management of the staff testing response, more support for the procurement team, someone to run virtual TTOs to outpatients, someone to manage all of the generous offers from local businesses, to cover staff who have gone off sick, etc… It’s really hard to run a long-burn major incident if everyone is at home.”

Another commentator builds on this theme

“In my acute trust many essential non-clinical functions are being decimated by self-isolation/ [covid-19 positive] results, [for example in] stocking areas, cleaning, portering, and there’s a role for all admin staff to be prioritised (sensibly) to keep these activities going. It should be an approach that looks at who is available and what is needed from them to keep the hospital running, recognising this will evolve rapidly… ie day-by-day, shift-by-shift.”

A third commentator was blunter in their response to non-clinical staff worrying about being given new roles.

“If administrators from CCGs are not willing to be redeployed, that is OK, they have a choice. However, then they should be asked to take unpaid leave at the least and their positions reviewed when this crisis is over. Apologies if this sounds radical, but taxpayers are not meant to be subsidising jobs and people that do not provide value when really required.”

A way forward

It is important to stress once again that in many NHS trusts and organisations, new working arrangements have been put into place with astonishing speed – the equal of anything happening in the private sector. Considerable sensitivity has often been shown to staff concerns and there have been heroic efforts from line managers and occupational health teams who have thought on their feet and sought forgiveness rather than permission when they needed to.

It is also the case that many NHS staff have switched to new, often discomforting tasks with attitudes ranging from eagerness to grim determination.

But in too many organisations, as we hope we have demonstrated, fear, anger and confusion is harming the NHS’ response to coronavirus. Line managers are worried about doing the wrong thing and feel hemmed in by the limits of their authority. They are also very busy.

What is needed is a clear statement of who should work where from the centre. For all that the service moans – often with good reason – about top down diktat, it does welcome clear guidelines in times of stress.

HSJ knows the limits of its expertise but would dare to suggest that national guidance should stress the importance of the service doing all it can to facilitate working from home, that staff should only be called into work if absolutely necessary, and that managerial and admin staff will be given the same kind of cover by regulators given to clinicians when they are forced to diverge from the normal way of operating. It should also highlight the need for some NHS staff to work, voluntarily, outside their comfort zones until the crisis is over.

Professor Julia Riley proposes a patient-focused strategy for care homes that would help implement a national digital advance care planning policy where advance care plans of patients are shared across all urgent care services

This editorial is not meant as a criticism of the efforts being made by the centre or senior managers working at a local level. HSJ knows better than most how hard they are working and – in most cases – how effective they are being.